What Is Hemodialysis Nursing?

The hemodialysis room, also referred to as the hemodialysis room, is a place where renal replacement therapy is performed for patients with chronic renal failure or acute renal failure due to related diseases using hemodialysis. It is a clinical department set up by the major internal medicine departments of hospitals at all levels in order to treat chronic renal failure or acute renal failure.

Hemodialysis room

The purpose of hemodialysis is to replace some of the functions lost by renal failure, such as removing metabolic waste and regulating water, electrolytes and acid-base balance. Its basic principles are dispersion, permeation, convection and ultrafiltration. The exchange of solutes and water during dialysis constitutes the theoretical basis for removing toxins, removing water, and supplementing necessary substances during hemodialysis. Small molecule substances such as creatinine, urea nitrogen and potassium in the blood of patients with uremia diffuse into the dialysate. The ion sodium, chloride and other ions in the dialysate have the same concentration in the blood. Bases, calcium ions, etc. diffuse into the blood, thereby achieving the purpose of removing toxins, correcting electrolyte disorders and acidosis.

The principle of ultrapure water for hemodialysis is the use of a dialysis membrane, which is a semi-permeable membrane that passes the relative flow of blood and dialysate on the inside and outside of the dialysis membrane. The lateral transport process is called diffusion; the result of diffusion makes the solute concentration on both sides of the semi-permeable membrane reach equilibrium. If a negative pressure is applied to the semipermeable membrane side to increase the transmembrane pressure, the water can be moved from the high pressure side to the low pressure side, which is called ultrafiltration. At the same time, some solutes move with the water, which is called convection.

Introduction of medical hemodialysis water treatment equipment

Hemodialysis equipment uses reverse osmosis membrane elements to select imported low-pressure and ultra-low-pressure roll-type composite membranes, which can not only remove charged ions, inorganic substances, and colloidal silicon in water, but also almost all organic, inorganic, and heat sources in water. Imported stainless steel The high-pressure pump can stabilize the reverse osmosis inlet water pressure and work longer. In addition, the device is also equipped with a programmable logic controller (PLC) to implement automatic detection and cleaning. At present, it has been widely used in medicine, preparations, beverages and food, metallurgy, electronics, chemical industry and other industries. The desalination rate of a single membrane element is above 99.6%, and the conventional water production of a single reverse osmosis device is 0.2-60T / h.

Preparation process of hemodialysis pure water

· Raw water-raw water pressure pump-multi-media filter-activated carbon filter-water softener-precision filter-first stage reverse osmosis-pH adjustment-intermediate water tank-second stage reverse osmosis (the surface of the reverse osmosis membrane is positively charged) -Purified water tank-Pure water pump-Ultraviolet sterilizer

· Raw water-raw water pressure pump-multi-media filter-activated carbon filter-water softener-precision filter-primary reverse osmosis equipment-intermediate water tank-intermediate water pump-ion exchanger-purified water tank-pure water pump-ultraviolet sterilizer- Micro-pore filter-traditional process of using water point

· Raw water-raw water pressure pump-multi-media filter-activated carbon filter-water softener-precision filter-primary reverse osmosis machine-intermediate water tank-intermediate water pump-EDI system-purified water tank-pure water pump-ultraviolet sterilizer-micro Pore filter-new process with water point ^[1]

Acute renal failure, chronic renal failure, drug poisoning, poisoning, fish gall poisoning, snake venom, hyperkalemia, pulmonary edema, metabolic poisoning, and difficult and critical illness.

(1) Acute renal failure (2) Chronic renal failure (3) Acute drug or poisoning (4) Refractory heart failure, pulmonary edema, cirrhosis, liver and kidney syndrome, nephrotic syndrome, electrolyte disorders, liver Encephalopathy, hyperbilirubinemia, hyperuricemia, schizophrenia, and psoriasis also have hemodialysis treatment effects.

The hemodialysis room should be equipped with conditions, places, facilities, equipment and personnel suitable for its functions and tasks.

The hemodialysis room should include basic functional areas such as a dialysis treatment area, a water treatment area, a treatment area, a waiting area, a consultation area, a warehouse, and a patient's dressing room. The functional areas should be reasonably laid out, and clean areas should be distinguished from polluted areas. Clean areas include dialysis treatment areas, treatment areas, water treatment areas, and warehouses.

The hemodialysis room should be equipped with a dialysis machine, water treatment device, basic rescue equipment, oxygen supply device, central negative pressure interface or removable negative pressure suction device, dual power supply system, and ventilation equipment.

The hemodialysis room should meet dialysis patients, and be equipped with a sufficient number of dialysis professional training and qualified medical personnel who have been appointed by the health administrative department for at least 6 months.

Independently established hemodialysis rooms should be equipped with at least 3 licensed physicians and implement a three-level physician responsibility system; for hemodialysis rooms located in relevant departments, their physicians can be uniformly arranged by the relevant departments, and there should be at least 1 attending physician responsible for hemodialysis Room for daily work.

The allocation of nurses in the hemodialysis room should be reasonably arranged according to the number of dialysis machines and patients, as well as the dialysis environment, and each nurse should be relatively concentrated and the number of patients should not exceed 4.

Hemodialysis room nurses should be proficient in the care and operation of hemodialysis machines and various hemodialysis channels, strictly implement various operating procedures, regularly inspect the operation of patients and machines, and make relevant nursing records.

The hemodialysis room shall establish and strictly implement a system of disinfection and isolation, a quality inspection system for dialysate and dialysis water, relevant technical specifications and operating procedures for diagnosis and treatment, and a system for operating records and maintenance of equipment.

The hemodialysis room should maintain fresh air, sufficient light, and a quiet environment to meet the requirements of hospital infection control.

(1) The clean area shall meet the requirements of Class III environment specified in the "Hospital Sanitation Standards";

(2) Effective air disinfection shall be carried out daily in the clean area;

(3) Bed sheets and sheets should be replaced after each dialysis, and all surfaces and floors in the dialysis room should be disinfected and wiped.

The hemodialysis room should establish a hospital infection control monitoring system, including environmental hygiene monitoring and infection case monitoring, analyze the causes and make rectifications. If there are serious hidden dangers, patients should be stopped immediately and patients in the hospital should be transferred out.

The hemodialysis room should be set up with an isolation treatment room or isolation area, equipped with a special dialysis operation supply cart to isolate and dialysis patients with hepatitis B, and the staff is relatively fixed.

Changing areas for medical staff and patients should be set up separately, and medical staff channels and patient channels should be established according to the actual situation. Medical personnel entering the clean area should wear work clothes and work shoes, and should follow medical care routines and diagnosis and treatment specifications when treating or nursing patients.

According to the requirements of the equipment, the water treatment system is regularly washed and disinfected, and the water quality is regularly checked to ensure that it meets the quality requirements. After each disinfection and flushing, determine the residual amount of disinfectant in the pipeline to determine that it is within the safe range.

The hemodialysis room should establish a quality monitoring system for dialysate and dialysis water.

(1) Bacterial culture is performed once a month for dialysis water, and specimens are collected at the place where the water enters the hemodialysis machine, and the number of bacteria cannot exceed 200 cfu / ml;

(2) Bacterial culture is performed once a month on the dialysate, and the specimens are collected at the place where the dialysate enters the dialyzer, and the number of bacteria cannot exceed 200cfu / ml;

(3) The endotoxin is tested once every three months in the dialysate. The method of specimen retention is the same as that of bacterial culture. The endotoxin cannot exceed 2eu / ml;

(4) Units with self-configured dialysate should regularly conduct a solute concentration test of the dialysate, leaving the specimens in the same way as bacterial culture, and the results should meet the requirements;

(5) The chemical contamination of dialysis water shall be measured at least once a year, and the hardness of soft water and free chlorine shall be tested at least once a week, and the results shall meet the requirements.

The hemodialysis room should establish a standardized and reasonable dialysis diagnosis and treatment process, formulate a strict admission system, and implement real-name management of patients.

The hemodialysis room should establish a file for the dialysis equipment, perform routine maintenance on the dialysis equipment, and ensure the normal operation of the dialysis machine and other related equipment.

The medical equipment, medical consumables, and medical supplies used in a hemodialysis room shall comply with national standards and be used and managed in accordance with relevant national regulations.

The hemodialysis room should establish a good communication channel between doctors and patients, perform notification procedures for patients in accordance with regulations, and safeguard patients' rights and interests.

The hemodialysis room shall establish a hemodialysis patient registration and medical record management system. Dialysis medical records include first medical records, dialysis records, laboratory records, medication records, etc.

Strictly enforce the rules and regulations for disposable items. Reusable hemodialyzers approved by the State Food and Drug Administration shall be operated in accordance with the "Haemodialyzer Reuse Operation Specifications" entrusted by the Chinese Medical Association entrusted by the Ministry of Health.